Knowing what EBD is and isnt is essential for practitioners

The ADA wants members to know it’s questioning the insurance industry’s use of the terms “evidence,” “evidence-based” and “EBD” and that individual dentists should too.

“Don’t make the assumption that because your insurers call their benefits ‘evidence-based’ that they really are,” said Dr. John Luther, ADA senior vice president, dental practice/professional affairs. “Ask why they are.”

The Association believes some insurers are using the terms to lend credibility to plan design, dental coverage and cost containment strategies, without employing a truly science-based approach. Efforts to persuade the insurance industry not to underestimate the need for correct methodology when using the term are going unheeded.

The ADA has a formal EBD policy statement, which includes a definition of evidence-based dentistry, as well as four primary steps for the evidence-based review process.

“Dentists should go to their Association to learn what EBD is and to understand its application in clinical practice,” said Dr. Luther. “The terminology linked with some benefits defined as ‘evidence-based’ may be simple sales talk.”

Dr. Daniel Meyer, senior vice president, ADA Division of Science, agrees.

“Insurers are developing benefits in their policies and saying they’re based on evidence by using proprietary, aggregate data from insurance claims,” explained Dr. Meyer. “This is not a transparent and reproducible approach. The ADA believes such a method can’t compare to the quality of evidence gathered from randomized, controlled, scientific studies in recognized peer-reviewed professional publications.”

The Council on Dental Benefit Programs, the Council on Dental Practice and the Council on Scientific Affairs collaboratively specified ADA concerns in a letter to America’s Health Insurance Plans (a national association representing some 1,300 member insurance companies). The ADA included a six-point outline in its remarks explaining key differences in the way the ADA and AHIP view evidence-based dentistry. The letter was drawn up based on AHIP’s report to dental plan members entitled “Guiding Principles for the Development of Quality Affordable Dental Coverage Based on Evidence.” (To read the entire ADA letter, go to OnlineXtra, Jan. 21, 2008, at ADA.org)

In its response to the ADA letter, AHIP appears to have evaded issues raised rather than addressed them, according to Dr. Deborah Bishop, 2008 EBD Advisory Committee and Council on Dental Benefit Programs member.

“It’s difficult to believe AHIP didn’t understand the points we specified,” said Dr. Bishop. “It seems to me that AHIP intentionally skirted the issues because they want to use the term evidence to lend clinical credence to financially based decisions.”

AHIP’s response, described by the organization as an attempt to provide the ADA with clarification on its concerns, highlights the ADA’s key criticisms of the way AHIP views evidence-based dentistry.

AHIP said its guiding principles indicate that evidence-based coverage guidelines are intended “to assist dental benefit plans and purchasers in choosing appropriate coverage to meet the clinical needs of the members while providing an affordable dental benefit package.”

The distinction between coverage and clinical guidelines is at the heart of ADA criticisms. The phrases “evidence-based dental coverage” and “evidence-based dental practice” cannot be used interchangeably, according to EBD experts.

“Using sources of evidence appropriate for the purpose of plan development and creating the impression that the recommendations are based on clinical scientific evidence is potentially misleading,” said Dr. Luther. “We’re not saying that financially weighted evidence isn’t appropriate for financial decisions, such as benefit plan development, only that calling it evidence-based gives the wrong impression.”

The ADA definition of evidence-based dentistry is:

“An approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient’s oral and medical condition and history, with the dentist’s clinical expertise and the patient’s treatment need and preferences.”

The ADA policy includes the four primary steps of the evidence-based review process: defining a clinically relevant question; synthesizing the available evidence that is relevant to the clinical question; translating that synthesis to the professional community; and evaluating health outcomes in clinical practice (based on the findings of the previous steps).

“The entire process aims to minimize the influence of individual bias in the systematic review and to develop justified clinical recommendations that address specific questions,” said Dr. Meyer.

“Evidence-based dentistry is designed to give dental providers and their patients the most relevant, scientifically based, clinical information to help optimize the care you provide for each patient,” continued Dr. Meyer. “It is intended to enable the dentist to exercise his or her professional judgment to ensure that the patient has the opportunity to receive the highest quality care that is based on the individual’s clinical treatment needs and preferences. Aggregate claims data about care that does not address the specific needs of your patient is not consistent with evidence-based dentistry principles鈥攁nd resulting constraints should not be referred to as evidence-based dentistry.”

The ADA urges dentists to go to their Association to learn about evidence-based dentistry and its application in clinical practice.

For links to tutorials and a wealth of other EBD information go to www.ada.org/goto/ebd.

For information about the May Evidence-Based Dentistry Champion Conference and 3rd International Conference on Evidence-Based Dentistry visit www.ada.org/goto/ebdconf, send an e-mail to ebd@ada.org or call the ADA Division of Science, Ext. 2878, for information.

The ADA Cell Seminar Series offers “Evidence-Based Dentistry: Practical Science.” The course reviews the concept of evidence-based dentistry, how systematic reviews are conducted, analyzes findings from published systematic reviews and demonstrates how scientific studies should be critically analyzed before they are applied in dental practice.

Dental societies interested in hosting this or any ADA Cell Seminar Series program can schedule a program or get more information by calling the ADA toll-free, Ext. 2908; e-mailing seminarseries@ada.org; or logging on to www.ada.org/goto/seminarseries.聽

Questions to ask insurers about what they call ‘EBD’

The ADA Council on Dental Benefit Programs, in collaboration with the Division of Science, recommends dentists ask their insurers the following questions:

• What is the insurer’s definition of “evidence-based”?
• Is it the ADA definition? Is the “evidence” cited actually financial data, not scientific data?
• Has the data gone through an external peer review process and been accepted for publication in a professional journal?
• Are the evidence reviewers EBD experts or financial experts?
• Are the insurers’ policies consistent with other existing EBD recommendations and guidelines, including ADA clinical recommendations?